The human circulatory system is a closed system in which blood circulation in the blood vessels takes place thanks to the pump, which is the heart. Blood pressure is the pressure of the blood stream against the walls of these vessels. When blood is pumped into the aorta and large arteries, the pressure is at its highest, it is the systolic pressure. During the diastole of the ventricle, the heart is in a calmer phase, preparing for the next contraction, then the pressure reaches its lowest value, i.e. the diastolic pressure. Blood pressure is measured in millimeters of mercury (mm Hg), during the measurement two values are obtained, determining systolic and diastolic pressure.
The ideal human blood pressure is 120/80 Hg, where 120 is the systolic (so-called upper) pressure, and 80 is the diastolic (so-called lower) pressure. For arterial hypertension, HA (from Latin hypertonia arterialis), the cardiologist recognizes the increase in blood pressure above the normal range, usually over 140/90 Hg. Hypertensive disease is defined as the case of periodically or constantly elevated blood pressure, both systolic (upper) and diastolic (lower). Hypertension is now considered a disease of civilization, it is one of the most frequently mentioned causes of premature death all over the world, especially in people living in the so-called "Highly developed countries".
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Symptoms
Sometimes arterial hypertension does not give any obvious symptoms or the patient does not associate them with this disease entity. However, the most common symptoms are:
- headaches; throbbing or dull feeling of pressure in the head,
- dizziness,
- tightness of the chest,
- feeling of "flapping" heart,
feeling short of breath, difficulty breathing
- epistaxis,
- ear noise,
flushing of the face, neck and chest
- tiredness,
- over-excitation, nervousness,
- sleep disturbances, insomnia.
If the above symptoms recur, the cardiologist will most likely order blood pressure measurements to find out what is the cause of the symptoms.Reasons for occurrence
The causes of arterial hypertension are divided into primary and secondary. The vast majority, over 90%, will be defined by a cardiologist as primary, i.e. without a clearly somatic cause that could be treated and removed. In this case, environmental factors are of key importance in determining the cause of hypertension. There has been a lot of talk about it lately, especially in the context of the constant stress that man is subjected to, in the "race of civilization" combined with an unhealthy lifestyle and low-nutritional food.
Secondary causes of arterial pressure occurrence are identified by the cardiologist in the context of other diseases that may cause it, e.g. diseases of the brain, kidneys or endocrine glands. Then the treatment of arterial hypertension is sometimes associated with the treatment of these diseases.
How common is the problem with arterial hypertension is evidenced by the fact that cardiology has a separate specialization and hypertension can be treated not only by a cardiologist, but since 2006 in Poland also by a hypertensiologist, a specialist in this field.
Obviously, the diagnosis of arterial hypertension is based on its measurement.
The Polish Society of Hypertension (PTNT) adopted in 2003 the classification of arterial hypertension. It is consistent with the classification of European societies ESH and ESC (European Society of Hypertension and European Society of Cardiology) published in the same year. This categorization is intended to facilitate diagnosis and subsequent treatment.
Classification of hypertension:
|
Category |
Systolic pressure (mm Hg) |
Diastolic pressure (mm Hg ) |
|
Optimum pressure |
< 120 |
< 80 |
|
Correct pressure |
120 – 129 |
80 - 84 |
|
High pressure normal |
130 – 139 |
85 - 89 |
|
Grade 1 hypertension (mild) |
140 – 159 |
90 – 99 |
|
Grade 2 hypertension (moderate) |
160 – 179 |
100 - 109 |
|
Grade 3 hypertension (severe) |
>- 180 |
>- 110 |
|
Isolated systolic hypertension |
>- 140 |
<- 90 |
The disease can be diagnosed and classified by a cardiologist only on the basis of multiple measurements of blood pressure, usually performed at intervals of several days, and sometimes even over a longer period of time. The patient is scheduled for regular blood pressure measurements. It also often happens that, apart from the measurement in a doctor's office or outpatient clinic, the patient receives recommendations to, if possible, take measurements at home and record their results. At home, it is recommended to take two measurements at short intervals twice a day, i.e. a total of four times.
Read more about home pressure measurement.
Apart from the blood pressure measurement results, the cardiologist diagnoses arterial hypertension on the basis of a detailed interview with the patient, description of symptoms and ailments. He also orders auxiliary research. They are designed to detect additional causes and risk factors for secondary hypertension.
Usually these are the following tests:
- blood count,
- CRP,
- glucose,
- sodium and potassium levels,
- calcium levels
- creatinine,
- lipidogram,
- uric acid
- general urine test,
- EKG (electrocardiography),
- Echocardiogram (Echo of the heart),
- chest X-ray,
- ultrasound of the carotid arteries and sometimes other organs, e.g. the abdominal cavity.
Of course, the cardiologist does not have to order all of the above-mentioned tests, but only those that he deems helpful in obtaining a complete picture of the patient's disease. In justified cases, it may propose other, extended tests.
Treatment of hypertension
Hypertension is often treated for life. It all depends on the symptoms, ailments and, above all, how far the level of hypertension is different from the norm. On this basis, the cardiologist makes a decision about the procedure.
Non-pharmacological treatment of hypertension is associated with constant lifestyle changes and mainly includes:
- fighting obesity and overweight by introducing an appropriate diet and physical activity;
introducing regular physical activity lowers blood pressure by 4-9 mm Hg,
- salt restriction; up to 4.35 - 6 g per day results in a reduction of blood pressure by 2 - 8 mm Hg,
- reducing alcohol consumption,
- to stop smoking,
- absolute end to drugs and other stimulants,
- reducing stress, learning how to deal with it, learning relaxation techniques,
- inclusion, if possible, of social therapy, consisting in relaxing activities and interpersonal contacts,
- doing sports, walking, exercising in the fresh air.
It happens that these actions will be enough to control high blood pressure, although they are not as easy as it seems. They require full cooperation on the part of the patient, understanding all aspects of changes and adhering to them for the rest of his life. The reward is the possibility of controlling not only arterial hypertension itself, but also slowing down or sometimes excluding other diseases, such as coronary heart disease, diabetes, kidney diseases, thyroid diseases and others.
Sometimes, however, a cardiologist offers pharmacological treatment.
It varies depending on the patient's disease, age and related conditions.
Drug treatment usually includes:
- β - blockers (β - blockers) - the most important group of drugs in the treatment of hypertension,
inhibit the activity of the sympathetic nervous system,
- ACE inhibitors - not only lower blood pressure, but also improve the prognosis of concomitant diseases; such as coronary artery disease, heart failure, diabetes, chronic kidney disease,
- diuretics (diuretics) - stimulate the kidneys to excrete water from the body together with the sodium contained in it, thus lowering blood pressure and preventing vasoconstriction,
- calcium channel blockers (calcium antagonists) - block calcium from entering the arteries causing them to contract,
- angiotensin receptor antagonists (santanas, ARBs),
- antihypertensive drugs and others.
In the treatment of secondary arterial hypertension, additional treatment is introduced to remove the underlying cause, i.e. the comorbid disease.
Pharmacological treatment is selected by the cardiologist individually for the patient, it is important to observe symptoms, monitor blood pressure, but also other periodic check-ups, such as blood and urine tests, eye fundus examinations, and periodically ECG and others. Sometimes one drug is used (monotherapy), but often it is necessary to take two or more drugs (polytherapy), sometimes for life. In the case of other diseases caused by arterial hypertension, the cardiologist may also refer the patient to specialists for other diseases. Never take any medication without consulting your doctor.
Read more about diet and rehabilitation for people with hypertension.Hypertension - consequences of lack of treatment
Hypertension is often referred to as the "silent killer", as it can be asymptomatic for years or with, for example, incidental headaches or temporary shortness of breath. Meanwhile, a destructive process continues inside the body.
The most common complications after untreated high blood pressure are:
- kidney damage - sometimes chronic renal failure ending in dialysis in a patient who has not been treated before,
- damage to the circulatory system - heart failure, initially usually the hypertrophy and thickening of the heart muscle, especially the left ventricle, stiffening of the arteries, in a further stage atherosclerosis, and even a heart attack,
- complications from the nervous system - ischemic and hemorrhagic stroke,
- in the elderly also common: eye damage; changes in the retina, dementia, problems with psychomotor skills and others.
Hypertension is called the epidemic of the 21st century. That is why it is so important to be aware of it and to prevent this treacherous and dangerous disease.
Hypertension - prevention
The introduction of prophylaxis in the case of arterial hypertension seems to be of key importance.
Each cardiologist will certainly recommend:
- physical activity selected according to the possibilities,
- an appropriate, healthy diet,
- inner calming down, reducing stress and acquiring the skills to deal with it, learning relaxation techniques,
- adequately long, healthy sleep.
There is a lot of talk lately about the so-called "Total wellbeing" or total self-care, awareness of what we eat, how we live, what we do, etc. In fact, the condition of our body depends primarily on us. Various relaxation techniques such as yoga, meditation, conscious breathing, listening to music, communing with art and nature help to maintain good condition of the body and spirit. Successful social relationships are also important.
Intentional extensive prophylaxis in the case of hypertension may bring unexpected results to the patient also in a broader sense; feeling happy about a good quality of life.
It is important to educate children in this area and to introduce a healthy lifestyle in children, from an early age. Only in this way can the hypertension pandemic be avoided.
Sources :
- Andrzej Szczeklik „ Choroby wewnętrzne”, Wydawnictwo Medycyna Praktyczna 2005
- Andrzej Januszewicz, Włodzimierz Januszewicz, Ewa Szczepańska-Sadowska, Marek Sznajdeman
„Nadciśnienie tętnicze”, Wydawnictwo Medycyna Praktyczna 2007 - Krystyna Widecka, Tomasz Grodzicki, Krzysztof Narkiewicz, Andrzej Tykarski, Joanna Dziwura „ Zasady postępowania w nadciśnieniu tętniczym”2011 – wytyczne PTNT
- Sylwia Sztuce – „ Rehabilitacja w nadciśnieniu tętniczym” - artykuł w czasopiśmie „Praktyczna fizjoterapia i rehabilitacja”, 2018
FAQ:
Yes, although it happens very rarely, about 1% of young children are diagnosed with arterial hypertension, usually secondary. After the age of 10, the pediatric cardiologist diagnoses primary hypertension more often. In any case, diagnostics should be started immediately to determine the underlying cause of the disease. In the absence of organ complications and constant medical control, it is recommended that the child not give up normal physical activity, it is even recommended to the appropriate extent. Children are treated similarly to adults, pharmacological treatment is based only on reduced doses of drugs.
Blood pressure changes in a pregnant woman are a physiological phenomenon. In the first and second trimesters, blood pressure drops, its lowest value usually occurs in the 23rd week of pregnancy. Subsequently, blood pressure begins to increase again and reaches the pre-pregnancy level by about 6 weeks after birth.
However, there are cases of hypertension in pregnant women and it is very dangerous both for the fetus and for herself. 5% - 10% of complications in pregnancy or childbirth are caused by untreated high blood pressure. Therefore, it is worth checking the pressure and in case of bad results, immediately contact the attending physician, and then the cardiologist.
There is no evidence of a direct genetic source of this disease. On the other hand, certain conditions and the specific lifestyle taken from home, parents and the immediate surroundings, which may affect the next generation, certainly have a great influence. Stressed, inactive, poorly eating parents will usually pass on such a pattern to the child, and in this sense it is a hereditary burden. Hypertension is detected in younger and younger people, which is why education in this field is so important.
